[musiclaying] hello, i am ivette torres and welcome to another edition of

the road to recovery . today we'll be talking about preventing, treating, and recovering from mental and substance use disorders within the context of the family. joining us in our panel today are frances harding, director, center for substance abuse prevention, substance abuse and mental health services administration, u.s. department of health and human services, rockville, maryland. dr. nancy young, executive director, children and family futures, irvine, california. erica asselin, family support specialist and medication-assisted treatment advocate, fresh start, square one, holyoke, massachusetts. dr. kim sumner-mayer, senior advisor, phoenix house center on addiction and the family new york, new york.

fran, what is the definition of family within our society currently? that's a very good question. family has changed, the definition. we used to think of family as two parents living in a house with two children and probably a pet or two. now, we have a wide variety of families. we have families that are one parent, single parent, being raised by friends, being raised by grandparents, relatives of all sorts. the good thing about that is it brings the ability of a lot of diversity, a lot of ethnic cultures are different, and i think that across america we have a lot better chance to have families describe themselves in the way that is most comfortable for them. and, nancy, it goes even beyond that. it goes into same sex parenting. it goes into a whole host of other issues, correct? yeah, and i think what's important is, as fran just said, you know, it's how the individual defines

for themselves who is their family. you know, i am the adopted mother of two children and i have also biological children and i have a stepdaughter and grandsons. so it's the way that i define my family and who's important to me for that support. right, and kim, it also depends on what society is doing to solve some of the problems that we're facing. families can be foster care. family can be a whole other context as well within that realm. yeah, absolutely. i think probably the best operational definition for family that comes to mind for me is it's a group of people who've established that they care about each other. they look to each other for support. they provide financial, emotional, housing support. it's, you know, where do you go for help when you're in trouble? and whose picture do you carry in your wallet? and whose birthday do you remember? and who matters to you? fran, how common are substance use and mental

disorders among families? it pretty much touches all families across the country in all different ways. you either have a substance abuse or a mental health disorder patient or consumer in your family leading the family. you could have children. you could have an extended family operation. you could also be living in a community that the person that you consider to be part of your family, even though there is no blood connection, could also be impacting the family. so it's a variety, unlike many other diseases and chronic conditions that we have. erica, how can family members begin to recognize that there's either a substance use or a mental health issues of concern within the family? i think that most importantly that you notice behavior changes.

maybe their routine has changed or the people that they are spending time with is different. start noticing that, you know, things aren't the same as they were. maybe as a parent, they are not getting up with their children in the morning and making breakfast and getting them ready for school and putting them on the bus like they used to. and, you know, when things start to look different, that's when that could be a red flag. and fran, how important is it to prevention strategies to recognize the early signs? very important. the earlier we can identify there's a problem in a family and then be able to start, begin to address it-and we'll talk later about the skills of being able to do that- we can prevent so many problems from happening and we can get somebody into treatment if they need it faster. we know that for young people, if we're able to postpone their use of alcohol and drugs they have a much better life ahead of them. mental health disorders can be diagnosed as early as 14.

often we are seeing signs as early as 11 and 12 that trigger that. so, it's very important so that we can prevent problems before they begin. absolutely. nancy, within the context of family again, what is the impact on the children of families where the adult may have an addiction problem or they may have a mental health problem? i think it varies based on which of those kinds of families you're talking about. i think it's important for us to think about the larger population of children. and we know that actually about 8.3 million kids in our country live with a parent who is an alcoholic or needs treatment for illicit drug abuse. that translates to 11 percent. think about an elementary school classroom, that's three kids in every elementary school classroom. that's sort of mindboggling to think about how many kids are affected by this particular addiction or illicit drug use in their family.

so when we think about the ways that kids adapt to that, and they cope with that, we can begin to see kids that do pretty well and may internalize what's going on in their family. they may not be vocal about it. they may not have the kinds of behavior things that would get attention in a school. and then, other kids may be those that start to act out and they are, you know, replacing some of the attention that perhaps they needed at home to try and seek that out by another adult. so i think it depends on which kind of situation you're dealing with, and how that particular child is handling and learning to cope with that situation. and you, at the center, deal a lot with the foster care system and helping families to gain a better sense of normality, whatever that may be, in order to assist families in staying together.

at what point does the system step in? right, so our organization is the contractor to samhsa and cofunded by the children's bureau, the national center on substance abuse and child welfare. in that role, we have seen many things happen that the systems are working together in different ways to identify earlier so that families that may get a first report of neglect. most kids and most families that come to the attention of the child welfare system are there for reasons of neglect rather than abuse or sexual abuse. in fact, we've made great strides in the country in the last decade at reducing the numbers of kids with physical and sexual abuse, and yet we haven't really changed that number on how many kids are in the neglect category of those reports. typically, we see that there are several reports before

child welfare steps in active services. there may be some investigations that go on. they are very adept now at being able to look at risk and safety factors for the child, to understand when that child is in imminent risk. what is "imminent risk"? so that our audience understands what we're talking about. child welfare, cps workers, child protective service workers have ways that they look at the risk factors in a family. imminent risk is: this is something that is critical and the child must be removed from that family right now in order to keep that child safe. so there's danger to their life? there's danger to their physical life, to their safety. meaning that the risk of who else is in the household can't be controlled so that there might be something going on that they need to say, right now, we need to make this removal. but there are about 200,000-a little more than 200,000 children removed each year.

whereas, there are about 3 million children that are investigated for abuse and neglect. and within those 200,000, are there cases where they are removed where the parents are having either a mental or substance use disorder? the vast majority. ivette, may i go back and kind of piggyback on what nancy was saying? you started by describing sort of what it looks like for a child who is in school and how they may present. and so to say what is happening at home in those situations, if you have a parent with a substance abuse problem, very often you're seeing children whose developmental needs are not the primary concern. and so the family is very oriented around meeting the parent's needs and keeping the family functioning around the parent's addiction. so rather than the child getting what they need developmentally, the family is really kind of putting the child's needs last in order to keep the family just functioning. so that sometimes means that children are actually flipping roles with their parents and becoming parentified, where they are in a role that is not appropriate for them.

the lines of authority are not clear or they change, depending on whether the parent is high or not high. so there is a lot of inconsistency for children. so, fran, let me go back. a child that is within one of these families, they're dealing with a problem many of them themselves in order to adapt, either develop a mental or a substance use pattern themselves. how-what happens in that dynamic? i think kim described it very well with the total dysfunction of the family and the family, if we don't intervene and find ways to go in and bring services to help them, the child can then get so confused and so frustrated from trying to be a parent and being a child at the same time, they separate themselves from their peers. and then they become frustrated and depressed and look for other outlets to get attention. as for the parents, they go through a similar issue:

they get frustrated and they have a guilt ridden inner core that then possibly brings them closer to having-becoming a depressed state or possibly medicating themselves to make them feel better. so we have to get services in there. we have to get education so that we can begin to link the services and begin to intervene as quickly as possible. and when we come back we're going to be talking a little bit more about the dynamics of a family that faces substance and mental disorders. we'll be right back. [music playing] when a family member has a substance abuse or mental disorder, it has a profound impact on the family unit. whether it is the young person who's having an issue and

its impact on the siblings and on the parents and their time and effort, their ability to get treatment and help that individual recover. but it's also what happens when a young person has a parent or an adult in their life who is struggling with addiction or who has a mental disorder. so helping the family unit deal with what's going on in the family, as opposed to dealing with just the individual who's having the illness or the addiction, is really critical. when the family discovers that a family member has a mental health problem or a substance use problem, the response of the family depends on the awareness of the family about the nature of conditions. families where there's a genetic environmental history may be more attuned to acting more promptly in an effort to acquire assistance or help for the affected individual because they've been there, done that, they recognize what's going on.

if the family is naïve about these conditions, again, the initial reaction may be one of denial, self-recrimination, feeling that somehow they've done something wrong. or conversely, maybe one of anger at how dare this person behave in such a way and shame-look what they're doing, depending on the cultural context and depending on the situation. so the full range of emotions associated with recognizing that there's a problem. [music playing] people who suffer from drug or alcohol addiction sometimes say hurtful things. they drive the people who love them most away. if you know someone who suffers from drug or alcohol addiction, listen. try to hear what they are really saying. know that there is hope and help them find their voice again. for drug or alcohol treatment referral for you or someone you know, call 1-800-662-help.

brought to you by the u.s. department of health and human services. [music playing] i have used methadone as my treatment for my disease of addiction, and by doing so i have been able to help other mothers that are on medication-assisted treatment. i think what the great thing about it is that because i've already walked that road, that in working with these mothers i get to bring them hope and to show them the light at the end of the tunnel and in some ways light that path for them, so that they can begin on their journey and walk down that path towards a beautiful life with their children in recovery. erica, does all of this seem familiar to you? the whole area of family dysfunction and substance and mental health issues?

very much so. i, myself, am in recovery and i am the parent to six children and my family-i became-using alcohol, and that roller-coastered into other substances, and it was very hard to keep the family dynamic together. how early in your age? i started using alcohol originally when i was 14 years old, but kind of took a break from that during my pregnancies, and i picked up again at age 25 and started drinking on a daily basis. and that turned into cocaine use and other substances from there. but what really ended up happening was my children paid the price for that. i wasn't able to be present for them and do the things that i needed to do. and i think what was most difficult about it was because of the stigma around being a mother and having an addiction and a family that i wasn't able to

seek treatment when i needed to. when it came time that child protective services became involved in my life, i didn't have the courage to admit that i had a problem, so i hid it. so instead of getting the treatment i needed, my children paid the price and they were removed. what was that ah-ha moment for you when you said, "this is it. i really need to get into help?" well, what ended up happening for me was i ended up losing-signing over my parental rights to my oldest children and giving guardianship of my youngest two to their paternal grandmother. and i really hit rock bottom after that. and it was very hard for me to even have a reason to live at that point. i had gone from being a mother of four to an absolute nothing. i had no reason to wake up in the morning and no coping skills whatsoever. but i ended up becoming pregnant again and it was at that moment that i said, "i am not willing to sacrifice another life due to my addiction," and

i immediately sought treatment and i have been in treatment-and have been clean and sober-ever since. that's wonderful, that's great. you know, i took the opportunity and ran with it, and i ran as far away from that dark side of my life as i possibly could. and i have taken the skills that i learned from being an addict and i used them in my work with helping other mothers in recovery. that's excellent. fran, basically beyond what erica has already said in terms of losing children and the cost. what other costs to society are there in terms of families that are experiencing mental or substance use disorders? there are several, almost too many to mention. we have young-if you start with the young kids, if you start with the children, the cost to society is that they often-we need extra costs to help them learn. they haven't had the type of parenting and discipline in the home to be able to keep up with their schoolwork, so they are behind, so that causes extra cost.

oftentimes, children in troubled homes that have addiction and mental health issues, they drop out early. and that's a huge cost to our society because they often then are not able to be employed. parents, just like erica was saying, sometimes because of the discrimination that is out there with people with substance use disorders and mental health disorders they won't get jobs, and so it's very hard for them to raise families. so you end up with a greater illness. you end up with costs around education. you end up with costs around relapse, when everything else begins again. it's a revolving door of extra medical and societal costs. so, let's talk a little bit about how we get families' help. kim, talk to us about family therapy and what is it. and describe it for us. sure. family therapy is no one particular approach.

it's really a collection of approaches to helping people make changes. and what these approaches all have in common is a belief in family level assessment and treatment, and by that we look at families as a system. so a system is something that has many different parts that interact with each other and all the parts have to be working well in order for the system to do its job. so family therapists look at the way individual family members function and how the family-the parts of the family, the individuals, the relationships-all work together. so we're interested in how individual behavior affects the whole and how the whole affects individual behavior. and we use relationships, really, as the site of intervention and the lever. and really, when it comes to addiction treatment, we're looking at two things. we're looking at what strengths and resources does the family have to bring to their-to help improve the recovery outcomes. and secondly, how can we use-how can we bring family members together in order to heal from some of

the effects of the addiction? so if i could go back to erica's story-amazing story, by the way, much respect to you-i wanted to talk a little bit about, you had said that your addiction had gotten so severe by the time you sought help. it's so common, for mothers in particular, not to seek help at the first signs because of stigma around treatment. so it got really bad and your children had been removed by the time you sought treatment. you were already in a very low place. and then when your children were removed, you experienced a tremendous well of grief and loss that plunged you down and probably-you said that's when you bottomed out. very common. but you said once you entered treatment you used a lot of your strengths and you learned a lot of skills. so family therapists would be interested in what are the strengths, what are the shining points, the exceptions to the problem story, in this family that we can use to leverage. so i would be interested in who was in your support network and

how did they help identify things like warning signs that you were headed in the wrong direction? so we leverage those strengths in family therapy. very good. fran, in terms of family therapy, how is it being integrated into the overall health care given the reforms that we're undergoing? many of our services are now being looked at for coverage in general health, health insurance. we have a long ways to go. we are trying-samhsa is actually is being quite the leader in helping our general health field and our insurance companies to be able to see that family therapy, educational classes, other medical and psychological services are indeed very appropriate for the consumers and the patients and the family members and people that are in long-term recovery, as it were, to get all of those services covered.

we have a long ways to go, but we are working very hard to get the country ready for 2014 when health reform will actually take hold in a bigger way and we'll have so many more thousands of americans that will have health insurance coverage that they've never had. we know from the research that when family therapy is integrated with substance abuse treatment, outcomes are enhanced. we know that we have better rates of engaging people in treatment, better rates of keeping people in treatment when they would otherwise drop out, improve long term outcomes, lowering societal costs of addiction, actually decreasing rates of domestic violence in families and decreasing or lessening the effects of addiction on children, and, therefore, interrupting that intergenerational cycle. well, that's wonderful. nancy, talk to me about the children and family futures and what they're doing to really help to integrate new approaches to reduce the number of individuals

that lose their children. well, we work with community members and the child welfare system, the addiction treatment and the mental health service system to ensure that they are communicating. that when a child is identified as having a parent with either a mental or a substance use disorder that that child is put-i loved the way that erica framed that she wasn't there and able-wasn't present to be able to take care of her children. and i resonate with that because i am the child of a mother with a serious mental illness, and i think we sometimes think of this as only being about addicted families. and yet those children in which parents have a mental health issue are also those that exhibit some of those same kinds of things. so when we're looking at what is happening in the life of that child, when is the issue of neglect such that

a formal system has to step in. and yet, there are many things that community members, church members, the faith community, school staff, you know, the individual that takes a young child and mentors that child can play just as an important role as the formal system. we are going to take a look at exactly that. how do we take a young person and how does society insulate that young person that may be experiencing a dysfunctional family scenario. we'll be right back. [music playing] before, addiction and depression kept me from living my life. and now, every step i take in recovery benefits everyone.

there are many options that make the road to recovery more accessible. it begins with the first step. join the voices for recovery. for information and treatment referral for you or someone you love, call 1-800-662-help. brought to you by the u.s. department of health and human services. [music playing] i think the exodus program is a rare opportunity to, it's one of those one-in-a-million shots

where you don't think that a place like this exists. the exodus program is a all-around supportive environment providing a safe and nurturing atmosphere for the families. we feel that the families progress through the program living life on life's terms because they experience everyday living. they take care of their children. they cook for their children. they get their children up to go to school. so the benefit of being in a one-shop model where everything is onsite is such a benefit to the families. i think, overall, the families here at the exodus program respond really well to just the genuine concern that our staff displays to them on a day-to-day basis. one of the things that we try to do as early on as possible is to try to have our clients develop a real positive support system.

whether it be through church, through meetings, through other peers that are here at the program, reconnecting with their family members. i think that's definitely the first step. well, having a place to live and being around other families that are like ours is very helpful because i feel like we get to help each other. and it's not just me getting help. i see that i am not alone. i enjoy that all of our family is together. everybody is focused and doing what they are supposed to do. i mean, it just makes us feel comfortable knowing that we have somewhere safe to be. i would say the most important things that i'm learning about my recovery is that there is hope, there is help. you learn something new every day especially when you are doing it under a clean and sober mind; it's a big difference. you learn how to deal with life situations as they come at you, in a positive manner, in a positive aspect, and that's the best thing that i seem to learn every day. i learn how to be a mother the way a mother should be.

the heros and sheros youth prevention program was developed to serve the 5- through 18-year-old youth of the parents that are receiving substance abuse services through shields for families. that program is a culturally enriched environment in which the children come to an afterschool program when they leave their elementary school and are provided tutoring, mentoring, one-on-one homework assistance. it's just a wonderful supportive leg for the families to have. we want to encourage these youth to go to school and further their education and let them know that anything that they want is obtainable. we also want to bring back the families. you know, we want to make sure that they are cohesive and they work well with each other and in addition we also want to build the community as a whole. we respect our clients, we value our clients' opinions about the services that are provided, and we listen real well to